Home health revenue cycle management grows up.
Getting paid is often the most difficult task for a home health or hospice agency.
Payments rely, in part, on third parties who have little or no incentive to complete important tasks in a timely manner, and the amount of documentation including referral documents and narratives can be overwhelming. At the same time, the market faces tough scrutiny from lawmakers and regulatory bodies. For instance, the U.S. Department of Health & Human Services Office of Inspector General recently reported that the home healthcare market is recognized as a “program area vulnerable to fraud, waste, and abuse.”
Thankfully, there are strategies you can use to slash the time it takes to get paid while at the same time, reducing your error rate and chance of audit. Below, find five tips you can use to do all of the above while improving patient care and profitability.
Create a strict patient onboarding process
The journey to get paid starts at point of intake when the phone rings or doctor sends over a referral creating a claim of care. Agencies need to collect all necessary documentation and information at that point so they are ready to process claims immediately.
Since there are so many moving parts, experts suggest creating a documentation checklist that lays everything out in a step-by-step process. The checklist should include a rundown of patient data that must be collected as well as what’s needed from the primary care physician such as orders and a plan of care. There should be a notation of when to follow up, too, starting on day one, says Craig Mandeville, founder and CEO of Forcura.
“You should have certain action items on the list. On day one, verify that documents were transmitted and received. On day 7, for example, you can call the office, verify they have oversight of the patient you’re checking on, and that they received the paperwork. On days 14, 21, and 30 you make another call.”
Go paperless
While a written checklist is better than nothing, significant benefits are realized when using an electronic document workflow hub, which takes structured and unstructured documents from all different sources – fax, postal mail, electronic medical records (EMR) – and consolidates them into a single repository. “Companies that are using our technology to automate and provide a workflow to track everything are seeing their number of collections go way, way down. In addition, over time they’re seeing their document turnaround time improve by 40 percent,” explains Mandeville.
Build better relationships
Agencies are at the mercy of doctors, who need to provide referrals and sign off on changes in care requirements. There’s also the question of regulations. Claims are only valid if a doctor’s signature is a result of a face-to-face encounter. You can’t have a caregiver who never actually examined a patient sign off on his or her treatment, and yet about 20 percent of referrals come from community physicians who are extremely busy, say experts, putting some of those orders into question – or onto a big pile of unsigned paperwork.
This is where it pays to make a personal connection. Home health agencies should consider sending a representative to visit primary care offices that are especially slow with signatures, says Rick Gundling, senior vice president for the Healthcare Financial Management Association based in Chicago. “Getting that documentation can be really difficult, but making a connection means you’re not just a nameless entity trying to get something filled out anymore, especially if you also use the visit to show that you’re part of that physician’s care management team. The doctor is going to appreciate that – because of your agency -- the patient will get continuity of care. It’s going to cut down on readmission rates, too, which is a plus.”
Make collections a daily practice
Making sure you’re getting paid – and getting paid correctly – can be a huge problem. It’s likely an agency can’t survive if it regularly receives denials or down coding. The fix: Make actual collections (not just paperwork) part of the regular billing routine. This includes following up on receivables that are older than 30 days. Billers should also take the old adage, bad data in, bad data out to heart since one mistake can halt a claim in its tracks.
“Billers need to track and monitor every day,” says Trish Tulloch, a senior consultant at RBC Limited, a health care-focused consulting firm. “We’re all just people and sometimes things aren’t accurate. Maybe a date of birth was input wrong or you didn’t do the number of visits you expected. You have to be asking yourself, ‘Is this payment timely? Are we getting paid the amount we billed?’”
Send it once and send it right
There’s a good chance that, as an agency, you’ve requested the same paperwork from the same provider multiple times. This is a problem for several reasons. Most important, if the provider goes to her inbox and sees multiple requests about the same patient she can get annoyed and stop referring. “We definitely see that the more times you send something, the less likely it is to come back,” agrees Mandeville.
Another issue: The office may fill out the multiple copies, sending them back without realizing it. A good fix for this is using a system that has a barcoding feature. “Any version that the provider sends back can come back and – in an automated way – go right into the system. This helps the agency capture, organize, and ensure they are fully compliant,” says Mandeville.
When these steps are followed, agencies are more likely to get paid quicker, and improve the revenue cycle. Even more important: Patients don’t get billing surprises, which improves their level of satisfaction, says Gundling. “Patients want to know that their financial obligations as soon as possible in the care process,” he says. “Good billing practices are just part of the overall patient experience.”
